In Acosta v. HealthSpring of Florida, the state’s Third District Court of Appeals explains that claims against a health insurance company for standard negligence are not subject to the various pre-suit requirements that govern medical malpractice claims against doctors, hospitals and the like.
Mr. Acosta sued HealthSpring in 2010, alleging that the health insurance company breached its contract with him and negligently performed the contract with respect to benefits the insurer provided Acosta after he suffered a stroke a year earlier. Specifically, Acosta claimed that the insurer decided to transfer him from the original medical facility treatment center where he sought treatment for the stroke to another, less costly, location, and unreasonably delayed moving him, exacerbating the effects of the stroke. He later amended the complaint to include medical malpractice claims against North Shore Medical Center, where he was originally treated for the stroke, and Dr. Rehan Naqui, who reviewed his file.
Florida law requires a person suing for medical malpractice to conduct an “investigation” to determine whether there are reasonable grounds on which to believe that the person’s injury was caused by medical negligence before filing suit. The plaintiff must also notify a prospective defendant of his or her intent to sue before filing a complaint in state court, including by providing an expert opinion corroborating that there are reasonable grounds to support the claim.
Acosta satisfied the pre-suit requirements with respect to North Shore and Naqui before filing the amended complaint. HealthSpring argued, however, that Acosta did not to meet these requirements with respect to his claims against the insurance company and instead failed to file a notice of intent to initiate a medical malpractice claim against it. A trial court agreed, granting summary judgment to HealthSpring.
Reversing the decision, the Third Circuit held that Acosta was not bound by the pre-suit requirements in his claims against HealthSpring because they weren’t medical malpractice claims. Acosta’s claims were for “ordinary negligence,” rather than “medical negligence,” according to the court. “Mere delay, albeit ultimately-critical delay, in arranging transportation to a different hospital to save money, may have involved negligence by clerical personnel of HealthSpring, not medical personnel,” the court explained. The court also said the matter was similar to that in its 2006 decision in Quintanilla v. Coral Gables Hospital, in which claims regarding an incident in which a nurse spilled a cup of hot tea on a patient were deemed not related to medical malpractice.
To the extent Acosta’s claims sounded in medical malpractice, the court further ruled that HealthSpring waived its pre-suit notice defense because the company didn’t raise it in response to Acosta’s first complaint, filed before he added the claims against North Shore and Naqui. The court remanded the case back to the trial court for further proceedings.
If you or a loved one was injured by poor medical care or negligence by an insurer, contact the South Florida personal injury attorneys at Anidjar & Levine. We represent clients throughout the area, including in Pompano Beach, Coral Springs and Boca Raton and offer a free initial consultation from our Fort Lauderdale offices. Call the firm today at 800-747-3733.
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